Provider Demographics
NPI:1356074918
Name:VALES, JONATHAN PAUL (DPT)
Entity Type:Individual
Prefix:MR
First Name:JONATHAN
Middle Name:PAUL
Last Name:VALES
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 C M FAGAN DR STE 103
Mailing Address - Street 2:
Mailing Address - City:HAMMOND
Mailing Address - State:LA
Mailing Address - Zip Code:70403-5963
Mailing Address - Country:US
Mailing Address - Phone:985-542-6664
Mailing Address - Fax:985-542-6428
Practice Address - Street 1:1100 C M FAGAN DR STE 103
Practice Address - Street 2:
Practice Address - City:HAMMOND
Practice Address - State:LA
Practice Address - Zip Code:70403-5963
Practice Address - Country:US
Practice Address - Phone:985-542-6664
Practice Address - Fax:985-542-6428
Is Sole Proprietor?:No
Enumeration Date:2022-07-01
Last Update Date:2022-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA11270225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist